Insights on treating an over-the-counter-type subgroup: Data from the Air Force/Texas Coronary Atherosclerosis Prevention Study population
Coronary Artery Disease
The expansion of therapeutic options for management of dyslipidemia is a potentially valuable avenue for the optimal treatment of most patients at low-to-moderate risk for coronary artery disease (CAD). In primary prevention, this population is closely approximated by that of the landmark Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). In AFCAPS/TexCAPS, 6,605 men and women without evidence of CAD and with average total cholesterol (180-264 mg/dL) and low-density lipoprotein (LDL)-cholesterol (130-190 mg/dL) concentrations and low high-density lipoprotein (HDL)-cholesterol levels (< or =45 mg/dL for men, < or =47 mg/dL for women) were treated with either lovastatin or placebo for a mean of 5.2 years. With few exceptions, the characteristics of the AFCAPS/TexCAPS cohort were similar to the profile of the majority of people in the United States and that of a potential over-the-counter (OTC)-type subgroup. The dosage of lovastatin used was 20-40 mg/day, titrated to achieve an LDL-cholesterol target of < or =110 mg/dL. Treatment reduced the combined incidence of fatal and nonfatal myocardial infarction, unstable angina, and sudden cardiac death by 37% (p<0.001). The risk for fatal and nonfatal heart attack was reduced by 40% (p<0.002), and the need for coronary revascularization procedures was reduced by 33% (p = 0.01). Post hoc analysis of data from a subgroup of the AFCAPS/TexCAPS cohort resembling those in the general population who may benefit from OTC statins indicates similar benefits. The results have important implications for the identification and treatment of persons at risk for coronary disease.